Objectives The aims of the study were to perform the first systematic review of pediatric syncope etiologies and to determine the most common diagnoses with credible intervals (CredIs). Methods Review was performed within Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and used Embase, Scopus, PubMed, and the Cochrane Controlled Trial databases. The following inclusion criteria for the articles were used: minimum of 10 patients, standard definition of syncope used, subjects who were 21 years or younger, and subjects who were either a consecutive retrospective group or a prospective group. No restrictions were made regarding language of the studies, but an English abstract was required. The following information was collected: purpose of the study, definition of syncope, number of patients, patient age range, inclusion/exclusion criteria, and etiologies of syncope. Results Of the 500 articles initially identified, 11 studies met the inclusion criteria and were the basis for this review. Three thousand seven hundred patients were included, ranging in age from 3 months to 21 years. The most common etiologies identified were vasovagal (52.2%; 95% CredI, 50.6–53.9), postural orthostatic tachycardia syndrome (13.1%; 95% CredI, 12.1–14.2), and cardiac causes (4.0%; 95% CredI, 3.39–4.65). A total of 18.3% (95% CredI, 17.0–19.5) of patients were found to have syncope of unknown cause. Conclusions Syncope is a common pediatric complaint. Most cases seen are a result of benign causes, with only a small percentage because of serious medical conditions. In addition, most syncopal episodes in the pediatric population are diagnosed clinically or with minimally invasive testing, emphasizing the importance of a detailed history and physical examination.

Purpose To develop a probability-based differential diagnosis for pediatric acute liver failure (PALF) based on age and socioeconomic status of the country of origin. Methods Comprehensive literature search using PubMed, EMBASE, and SCOPUS databases was performed. Children 0–22 years of age who met PALF registry criteria were included. Articles included >10 children, and could not be a case report, review article, or editorial. No language filter was utilized, but an English abstract was required. Etiology of PALF, age of child, and country of origin was extracted from included articles. Results 32 full text articles were reviewed in detail; 2,982 children were included. The top diagnosis of PALF in developed countries was acetaminophen toxicity (9.24%; 95% CredI 7.99–10.6), whereas in developing countries it was Hepatitis A (28.9%; 95% CredI 26.3–31.7). In developed countries, the leading diagnosis of PALF in children aged <1 year was metabolic disorder (17.2%; 95% CredI 10.3–25.5), whereas in developing countries it was unspecified infection (39.3%; CredI 27.6–51.8). In developed countries, the leading diagnosis in children aged >1 year was Non-A-B-C Hepatitis (8.18%; CredI 5.28–11.7), whereas in developing countries it was Hepatitis A (32.4%; CredI 28.6–36.3). Conclusion The leading causes of PALF in children aged 0-22 years differ depending on the age and developmental status of their country of origin, suggesting that these factors must be considered in the evaluation of children with PALF.

INTRODUCTION: For emergency contraception (EC) to be effective, it has to be readily available. Thus, in 2013 the FDA approved EC Levonorgestrel (LNG) for sale over-the-counter (OTC) without a prescription or age limit. Although requiring a prescription, Ulipristal acetate (UPA) approved in 2010 for EC may be more effective than LNG in certain circumstances. We sought to determine the accessibility of these EC medications at pharmacies in the Lehigh Valley Area of Pennsylvania (population 850,000). METHODS: Phone surveys were conducted of Corporate and Independent pharmacies. Only the pharmacist or pharmacy tech provided information about availability, age requirements and accessibility of EC. Corporate and Independent pharmacies were compared using chi squared test with appropriate correction. RESULTS: The EC survey included 104 Corporate (CorP) and 26 Independent pharmacies (IndP) in the prescribed area. EC was in stock in 95/104 (91%) of CorP and 14/26 (54%) of IndP (p<.001). UPA was in stock at 12/104 (11%) of CorP and none of the IndP (p=.15). Age restriction was noted in 24/104 (23%) of CorP and 8/26 (31%) of IndP (p=.58). LNG over the counter location was found in 75/104 (72%) of CorP and 2/26 (8%) of IndP (p<.001). CONCLUSION: Although regional differences may apply, the availability/accessibly of EC is not ideal. Although the corporate pharmacies appear better than independents, the lack of UPA is a concern. Physicians should be aware of the availability of EC in their area.